TagGawande

November 22, 2018 / David Gratzer / Comments Off on Reading of the Week: Computers & Health Care – Dr. Gawande’s New Essay on “Why Doctors Hate Their Computers”

From the Editor

I’m running late – and I’m more than a bit concerned. I need to get to a meeting at the other campus, but first, I need to discharge a patient. That involves printing out a prescription and writing a short note. I’m in my fourteenth year of inpatient work, not counting residency, and I’m pretty good with prescriptions and notes. I believe I can do this. But does the EHR believe I can do this?

Many of us are frustrated with electronic health records (EHRs). In this week’s selection, we consider a new essay by Harvard University’s Atul Gawande, a surgeon, who considers EHRs and practice. Dr. Gawande talks about his own struggles with computers, and ties into the larger literature.

Big computer system, big problem?

We discuss his essay, and the potential and problems of EHRs. We touch on the Canadian experience and wonder about quality improvement. To that end, we look at “Getting Rid of Stuff,” just published in The New England Journal of Medicine.

To answer that question, we look this week not to a medical journal, but to The New Yorker. We consider an essay not on new drugs or imaging, but on the quiet rise of… primary care.

Primary care and the future

Dr. Atul Gawande writes a long essay on the virtues of primary care. Considering how medicine has shifted from acute care to chronic illness, he describes the importance of primary care, drawing on his own training and thinking – and the cardiac issues of his son.

Though this essay doesn’t directly consider mental illness, it is very relevant.

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful.

So begins Dr. Atul Gawande’s recent essay in The New Yorker, which I have chosen as this week’s Reading.

It asks a simple question: what can we do about this?

Dr. Atul Gawande

Dr. Gawande, a general surgeon at Brigham and Women’s Hospital, is a prolific writer; he is a frequent contributor to The New Yorker and has penned several bestselling books, including Being Mortal and The Checklist Manifesto.

In this piece, Dr. Gawande focuses on overtreatment. Indeed, the title is a good summary: “Overkill.” Continue reading